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Isico: our research on the roof of the world

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ISICO specialists, starting with Prof. Stefano Negrini, scientific director, and Michele Romano, physiotherapy director, are at the top of the world’s research rankings with research on SEAS – Scientific Exercise Approach to Scoliosis, and the revolutionary Sforzesco brace, which has proven its efficacy in replacing plaster casts in the treatment of scoliosis.

The data from three studies (Global research hotspots and trends in non-surgical treatment of adolescent idiopathic scoliosis over the past three decades: a bibliometric and visualization study, Exercise therapy for adolescent idiopathic scoliosis rehabilitation: a bibliometric analysis, A bibliometric review and visual analysis orthotic treatment in adolescent idiopathic scoliosis from the Web of Science database and CiteSpace software) says so.

These studies have just been published and are the first to map the scientific knowledge of research on scoliosis conservative treatment using visual research techniques by examining its hotspots, frontiers, and evolutionary trajectories, aiming to give an in-depth overview of the research status and developments in this subject, serving as a reference for researchers. 

Alan Pritchard introduced the scientific approach known as bibliometrics in 1969, monitoring data relevance and projecting future limits are aided by it. Researchers may comprehend the breadth of pertinent studies and efficiently promote information integration with the help of bibliometric analysis and its visualisation.

“These are the first three bibliometric analyses and visual analyses of orthotic treatment in adolescent idiopathic scoliosis that were taken into account from 1990 to 2023. In total, over a thousand articles and a total of 1005 records were included,” explains Prof. Stefano Negrini. “In Isico, we have 283 publications indexed in the last twenty years; 71 have dealt with scoliosis and braces and 37 with our SEAS approach. Numbers that, together with these recent bibliometric analyses, photograph the commitment and quality of years of constant and constantly growing scientific research”.

Scoliosis and conservative treatment: what we know
Adolescent idiopathic scoliosis (AIS) is a three-dimensional spinal deformity that develops in teenagers for unexplained causes. The guidelines of the International Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT), are presently the treatment recommendations and the basis for available treatment choices.

For children with a Cobb angle between 26° to 45°AIS, bracing is the suggested nonoperative treatment option; for those with Cobb angles larger than 40° to 45°, surgery is advised. On the other hand, some parents and children with AIS insist on wearing a brace instead of having surgery performed. According to recently published meta-analyses, bracing can also reverse the progression of scoliosis curves from 40° to 60°. 
Nevertheless, no bibliometric investigation has yet been done in this area.

Top of the class
1) The countries
China and Turkey are the only two of the ten countries with the greatest publishing output, categorised as developing; the other eight are categorised as developed. With 1,261 citations, the USA’s study was the most referenced, followed by China (977) and Italy (576).
The United States of America has the greatest annual publication volume, the longest length of research in this field, and the earliest start. China has the second-largest yearly publication volume, with a late start but quick development. It has grown remarkably every year, particularly in the last few years, and currently holds the record for the nation’s highest proportion of yearly publications. 
Both are followed by Canada and immediately after by Italy, which comes in fourth place with 47 published articles.

2) The researchers/ High-impact authors
According to the study Global research hotspots and trends in non-surgical treatment of adolescent idiopathic scoliosis over the past three decades: a bibliometric and visualisation study, of the 3,472 authors included in the visualisation atlas, 15 have published more than 10 articles. And here, too, Italy with Isico is among the top five in the world: three positions are occupied by Canadian authors, one by a Chinese author, and the fifth by Prof. Stefano Negrini, scientific director of our institute, for the number of articles published. In the classification, in the tenth place in the world, we also find Dr. Fabio Zaina, a physiatry specialist at Isico.
Prof. Stefano Negrini is in first place regarding the frequency of citations.
The new SOSORT 2016 guidelines, published by Prof. Stefano Negrini et al. in 2018, had the highest burst intensity among the 25 burst citations with the most co-cited literature, according to an evaluation of the Web of Science database. It focused on the background of idiopathic scoliosis, described conservative treatments for various populations, provided flow charts for clinical practice, reviewed the literature, and made recommendations regarding bracing, PSSE, assessment, and other conservative treatments.
It should be noted that Prof. Negrini is also in seventh place with the 2011 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth.
Instead, the study Exercise therapy for adolescent idiopathic scoliosis rehabilitation takes into consideration the top 10 active authors who have published literature on exercise therapy for AIS rehabilitation, and here Isico is on the roof of the world: Prof. Stefano Negrini is in the first place, followed by our physiotherapy director Michele Romano, while in the fourth and fifth places, we find Dr. Fabio Zaina and physiotherapist Alessandra Negrini.
The authors of this latest research write: “With 287 citations overall and an average of 47 citations per manuscript, it shows that the Italian Scientific Spine Institute is placed top in terms of citations per paper. Furthermore, the H-index could fairly represent the author’s academic accomplishments. With the highest ranking on the H-Index, Negrini Stefano is the most influential person in this sector. 172 publications have been published thanks to the efforts of this group of authors, with Negrini Stefano taking the lead. The team focuses on rehabilitating idiopathic scoliosis during growth, particularly through treatment with specific exercises”.

Dress green with us in June

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As every year, Isico dresses in green throughout June with a particular initiative. 
During the four weeks of the month, we will release dedicated posts on our social networks where each time we will share something different: a video, a testimony or an image to talk about scoliosis and how it is possible to live your daily life and overcome the difficulties of a demanding therapy.

Isico will be also part of an initiative organised by Tratando Escoliose/Brazil who realised together with the Associação Brasileira de Tratamento da Escoliose (ABTE), the First Scoliosis Event exclusively for patients and families.
Concerned about the quality of the information that reaches those who are in search of adequate scoliosis treatment for their kids, ABTE and “Tratando Escoliose” want to facilitate the meeting between national and international health professionals, renowned in the field of scoliosis, clearing doubts and insecurities.
Isico will be represented with a short video given by our physiotherapy director Michele Romano on the importance of patient education, through informative material, to better understand the how and why of treatment and the importance of a strong team following the path.
Follow us too, wear green and share our posts with the hashtag for the event ##scoliosisawarenessmonth

Ready for SOSORT

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There are just a few days and the SOSORT  International Conference finally, after two years from the start of the pandemic, is back in person in San Sebastian, Spain from the 4th to the 7th of May.
It will be the usual pre-course, scheduled for May 4, to kick off the event: three of our specialists will participate in the round table, Dr Fabio Zaina, with a session on Overview of Adult Spinal Deformity classification, and how it is differing from AIS, Dr Sabrina Donzelli with  ASD prevalence and Dr Michele Romano, director of Isico Physiotherapy, with Standardized presentations describing assessment, clinical decision making process and treatment.

In the following days, Isico will be present again with three presentations: Dr Fabio Zaina will present on May 6th “Night-time bracing improves back pain in patients with painful scoliosis: six months results of a retrospective controlled study“, Dr Michele Romano on May 7th “Exercises for adolescent idiopathic scoliosis: Updated Cochrane Review”  and finally, Prof. Stefano Negrini, scientific director of Isico, will compete for the SOSORT Award with his research “Splitting Growth into 3 Phases with Cut-offs at Pubertal Spurt and Risser 3 Facilitates Prediction of Progression. A Study of Natural History of Idiopathic Scoliosis Patients from age 6 to End of Growth”.

For more info: https://sansebastian2022.sosort.org

SEAS lands in France!

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SEAS – Scientific Exercise Approach to Scolisis has taken an important symbolic step. The first training course for physiotherapists was organized in France beginning of October. The implication, almost exciting, is that the location of the course was Lyon.
This place represents the historical cradle of scoliosis treatment. The city where the corrective plasters, the Lionese brace and the homonymous method of exercises were conceived which inspired all Italian physiotherapists when the concept of conservative treatment of spinal misalignments landed in Italy.
Even the SEAS can count among its ancestors the method of exercises conceived by the surgeon Pierre Stagnara at the “Centre des Massue”, the hospital that was the destination of all those who in the period between the 60s and 80s were on pilgrimage to learn how to systematically approach the treatment of scoliosis.
The SEAS was originally inspired by the simplistic concept of Lyon’s self-correction and then developed with the modern vision of rehabilitation treatment, creating the basis for the development of an approach based on the principles of conceptually advanced motor learning.
“This is the aspect that the students of this first French course appreciated -explains Michele Romano, Physiotherapy Director of Isico – About half of the class of 20 participants was made up of teachers from physiotherapy schools who came together for the discovery of SEAS. The concepts exposed and the linearity of the reasoning enthusiastically impressed the students“.
At the end of the course, the next appointments have already been scheduled and SEAS will meet new followers next year among others in Paris, Toulouse and Corsica.

Congress in Bulgaria: Michele Romano awarded

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In Sofia/Bulgaria, September 11-12, 2021 the VIII National Congress of the Association of Physiotherapists in Bulgaria: “Interdisciplinary approach and current trends in practice” took place. 
Both the current trends in practice on a national and global scale, as well as the future development of the profession in Bulgaria were discussed during the Forum. The scientific program once again provided an opportunity for the exchange of information and innovations in the field of physiotherapy and rehabilitation – national experience and world achievements.
The congress had a special section for the treatment of scoliosis and Michele Romano, head of physiotherapy in Isico, gave two presentations.
One was titled “Scientific Exercises Approach to Scoliosis (SEAS)” and the second one focused on “Scoliosis Manager”: the Isico web tool for patients’ management available free for everyone. In its protected version adapted to Isico’s internal clinical and rehabilitation needs, it is the daily working tool for Isico’s expert professionals. 
Further to giving these two presentations, Michele Romano was awarded a commemorative plaque by the Bulgarian Association of Physiotherapy, who wanted to express with this recognition their gratitude for his ongoing commitment and dedication in the field of physiotherapy.

Telephysiotherapy in Isico: the published research

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In this pandemic year a lot has changed in our daily habits, much in the way we work. Something also in the way we treat patients. We had to adapt to take opportunities from difficulties. In Isico, we have done this from the beginning, overcoming the first phase of closures thanks to the online mode of medical visits and physiotherapy treatments.

It was a way not to leave our patients alone and not to waste the efforts made, a way that after some time has become an integral part of our therapeutic proposal.

We learnt a lot and this also translated into the research, published recently by the Spine Journal, “Lessons learnt in two months of the exclusive application of telephysiotherapy instead of classical physiotherapy during the lockdown in Italy“. 

“Current evidence on telemedicine mostly refers to interventions not requiring hands-on approaches, based on either technology or oral/visual interactions – explains Michele Romano, director of Isico physiotherapy and author of the research –  In a way, the pandemic offered a sudden push to telemedicine. The question is which lessons can we learn on telephysiotherapy after a few months of extensive and mandatory experience?” 

For this reason, we want to share the experiences of exclusively telephysiotherapy treatments acquired by 38 physiotherapists working for Isico during the 2 months of lockdown from March 16th to May 11th.

It was crucial in the first phase that patients accept telephysiotherapy. Usually, the appointments are managed by the booking call-center, but after the first phone calls it was clear that this unusual and unexpected change proposed by a secretary was not well received by the patients.

Consequently, the new standard is that the appointment is made by phone call by the treating physiotherapist him/herself. That facilitates the interaction with the patient, and allows to professionally answer all eventual doubts.

How to organise to be able to carry out physiotherapy treatments online?  “An involvement of caregivers and families is necessary for the session. A free video-communication App is used (Skype or Meet) – explains Michele Romano  – Evaluation results autonomously collected by patients with the help of a caregiver, are sent before the session to fill the assessment form in advance. One caregiver is present during the session, with one camera to film the patient, to help correct mistakes and observe the right execution of specific exercises; a second device is used for the Institute App to record the exercises”.

During 2 months of lockdown, telephysiotherapy sessions have been 2,239 (100%). After the lockdown, when back to “normal” were face-to-face hands-on physiotherapy, 10% (532 out of a total of 5,091) remained telephysiotherapy sessions.

“The common feeling of patients and their caregivers was of not having been abandoned – explains Michele  Romano –  during these months we verified that the systems work properly, now this wide and sudden experience is available for the worldwide physiotherapy community. Telephysiotherapy is a not so difficult, readily available instrument.“

Obviously, limits and drawbacks referred by physiotherapists and patients included the impossibility to use hands-on, the need to simplify the approach, the limited attention of younger patients, the connection difficulties.  

Most physiotherapists and patients agreed that this type of approach is perfect in emergency, but it cannot substitute normal physiotherapy sessions in normal times.

“Yet we have found – concludes Michele Romano – that there is a group of patients who have discovered telemedicine and continue to use it even now, an additional opportunity that therefore in Isico we have decided to offer patients in the future, alongside the classical medical visits and physiotherapy treatments performed in-person.”

Message in a bottle: an Isico research

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Isico’s study, “Torsion bottle, a very simple, reliable, and cheap tool for a basic scoliosis screening“, published by Scoliosis and Spinal Disorders, demonstrates how and why scoliosis can be identified using a bottle of water. 

“One of the reasons that make scoliosis a disease that scares so much the parents, is its specific characteristic of being difficult to detect on its onset – explains Michele Romano, director of physiotherapists in Isico – A scoliometer is a professional medical instrument used by specialists such as doctors and physiotherapists to detect the pathology. In the absence of this instrument, is there a simple test for scoliosis that we can do in our own homes? Yes, the Torsion Bottle. Our paper aimed to check the possible usefulness of a simple tool (the Torsion Bottle) developed to offer an instrument for home-use by parents but also for screening purposes in low-income countries”.

The study was divided into two parts. The main purpose was to compare the measurements collected with the torsion bottle and the same measurements collected with the scoliometer in a population of patients accessing our clinic for the rehabilitation treatment following Isico standard evaluation protocols.

The secondary aim was to verify the reliability of blinded inter-operator assessments, performed with the torsion bottle on the same patients by two physiotherapists. These double-blinded measurements were taken periodically for a short-time-interval in our clinic to verify measurement accuracy in the everyday clinical activities.

The conclusion? The torsion bottle is useful to perform a pre-investigation of the presence of a prominence, permitting a simplified assessment of its value, thus referring to a specialist for a medical assessment.

We remind you that you can perform a quick and simple assessment/check for scoliosis or curved back on the website screening.isico.it,where you are simply asked to take some measurements with easily procurable tools like a ruler and others again to be detected with the help of a simple bottle of water, the Torsion Bottle. 

Seas: how it evolves to move forward

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Due to the Coronavirus emergency and the consequent restrictive measures, our SEAS courses, foreseen in different countries of the world in the next period, cannot be done: we are ready to reschedule them as soon as possible.
In some cases, however, SEAS has been able to evolve in online mode in order not to stop completely.
After the four-handed course in Moscow when Michele Romano, director of physical therapy in Isico, was connected online from Milan, we were invited to hold a theoretical Webinar in Turkey, a few days ago, on April 22nd.
In both cases it was a success beyond expectations, considering that the Webinar had 600 participants. During the Webinar, Dr Michele Romano explained what SEAS is, the scientific evidence of this type of approach to the treatment of idiopathic scoliosis and how it will evolve after the epidemic.

About Seas Course in Moscow, the lessons were given by our director of physiotherapy, Michele Romano, who linked up with 21 participants in Moscow, together with the course organiser Dr Dimitri Gorkovsky, who is a sports physician and specialist in physical and rehabilitation medicine.

“As the current situation prevented me from going to Moscow in person, as originally planned, we took a last-minute decision to switch from a residential to an online course” Romano explained. “A fundamentally important role in the success of this event was played by Dr Gorkovsky, who, since 2016, has worked with us on the staging of eight previous courses in various Russian cities: Moscow, St. Petersburg and Novosibirsk.”

On all these previous occasions, Dr Gorkovsky flanked Romano, translating from English into Russian.
“Those past experiences certainly helped me this time, as I am now familiar with the topic” he said. “Michele gave practical demonstrations using a dummy, which we watched via Skype, and I then replicated these exercises with volunteers from among the participants. Instead, Michele was able to answer the participants’ questions and clarify their doubts directly, as though he were here with us. The course was excellent, as usual, and the participants were very satisfied with what they learned. This remote modality could certainly represent an important opportunity for the future.”

Teleprevention: a video

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If we analyse it, movement, in general, is part of different aspects of our lives: knowledge, therapies, human relationships… And, of course, we are also talking about physical activity: our body in motion! 

More than anything, movement promotes wellbeing, mental as well as physical, and above all, it helps to prevent conditions of the kind our specialists deal with, such as low back pain and neck pain. The more we move, the less susceptible we are to such ailments.

Our director of physiotherapy, Michele Romano, has prepared a video in which he explains how to prevent back pain and presents a series of simple exercises to be done at home.
They take up very little time and you don’t need any equipment to do them: preventive exercises in telehealth mode
Share our exercise programme using the hashtag #isicotelemedicine. 

Take a look at the video!

Isis Navarro at Isico headquarter

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Could you tell us about your studies?

I am a PhD Student at Universidade Federal do Rio Grande do Sul. Since 2017, after I completed the SEAS course, I started to have only patients with scoliosis and work just with these patients. In my master’s degree I studied the surface topography as a possibility of easy and three-dimensional tool to evaluate scoliotic patients. I had some publications based on this primary subject.

https://www.sciencedirect.com/science/article/abs/pii/S0966636218303126

http://www.fortunejournals.com/articles/thoracic-idiopathic-scoliosis-establishing-the-diagnostic-accuracy-and-reference-values-of-surface-topography.html

And I have also some articles accepted for publication:

NAVARRO, ISIS J.R.L.; CANDOTTI, CLÁUDIA T. ; FURLANETTO, TÁSSIA S. ; DUTRA, V. H. ; AMARAL, M. A. ; LOSS, JEFFERSON F. . Validation of a mathematical procedure for the cobb angle assessment based on photogrammetry. Journal of Chiropractic Medicine (Print), 2019.

NAVARRO, I. J. R. L.; CANDOTTI, CLÁUDIA T. ; AMARAL, M. A. ; DUTRA, V. H. ; Gelain, G. ; LOSS, JEFFERSON F. . Validation of the measurement of the angle of trunk rotation in photogrammetry. JOURNAL OF MANIPULATIVE AND PHYSIOLOGICAL THERAPEUTICS, 2019.

What is your profession?

I am a physiotherapist.

Why did you register for the SEAS  course?

I was looking for the SEAS course, and my plan was to travel to Italy to attend the course, but fortunately Michele and Alessandra came to Brazil to teach for the first group in Brazil. I discovered the SEAS approach doing lots of researches on internet, searching for consistent methods of treatment to scoliotic patients to offer to them the best possibility of treatment and results.

What makes the SEAS learning course different from other educational courses and programs?

The more significant advantage of the SEAS course is the clarity of the reasoning behind the technic and the facility to apply what you learned. The SEAS approach allows doing physiotherapy with all type of scoliotic patients, independent of the type or classification of the curve. The teachers were always ready to answer all the questions and help with difficult cases I asked separately.

Are you satisfied with what you have learned? 

Yes. But when you start to practice more and more always news doubts arise. 

If you were asked to recommend the course, what would you say?

The SEAS course is an excellent way to understand the world of scoliosis, its characteristics and the reasoning to treat adequately and accurately. After the course, you will be able to evaluate and treat scoliotic patients based on a method easy to understand and to apply with a high level of scientific evidence.